Atopic Dermatitis: An update for parents

Atopic dermatitis (AD), a chronic skin condition, causes dry, itchy, and red skin; and affects more than 1 in 10 children. It results from dysfunction of the skin barrier and an imbalanced immune system. Children with AD often have sensitive skin.

AD is known to run in families. Many patients possess low levels of a skin protein called filaggrin (that helps keep in moisture and prevents irritating substances like bacteria and allergens). Nearly one-third of patients with AD also have other allergic diseases, like asthma, allergic rhinitis, or food allergies. More severe AD is linked with a more significant risk of these other allergic disorders. Symptoms of AD can interfere with sleep, social situations, and school. These patients can also develop bacterial and viral skin infections.

AD can appear at any age, and the skin rash is often comparable in patients of the same age. Infants present dry, rough, red, and itchy skin on their face, scalp, trunk, arms, and legs, while children often show involvement in the creases of their elbows, knees, and neck. The affected skin may appear darker or lighter than red in patients with darker skin tones.

AD transformations over time. The severe episodes are known as flare-ups, which may occur due to a wide variety of exposures such as irritants (soaps, detergents, scented products, cigarette smoke), the environment (temperature and humidity changes, allergens), and stress.

AD is often diagnosed when itchy, dry, and inflamed skin affects typical areas of the body. Laboratory tests are usually not needed to diagnose AD. Its initial treatment involves removing contact with irritating substances and repairing the skin barrier with a moisturizer. These patients are advised to take a lukewarm bath or shower daily and use only fragrance-free and dye-free products. They need to apply a thick layer of fragrance-free and dye-free moisturizer to all skin after bathing and at least one additional time each day. Patients with mild AD may be advised to add an over-the-counter or prescription cream or ointment to affected areas of skin during a flare-up. At the same time, those with more severe diseases may need to use prescription creams or ointments on a scheduled basis to control their symptoms. Some patients may benefit from diluted bleach baths 2 to 3 times per week, while those with a large allergic component to AD may improve over time with allergen immunotherapy, either under the tongue or allergy shots. Newer treatment options for these patients are prescription oral or injectable medications.

Some children will outgrow AD, but for others, it may persist through adulthood. It is essential to acknowledge that AD is not contagious, and the presence of a rash should not thwart school attendance.

Wheeler KE, Chu DK, Schneider L. What Parents Should Know About Atopic Dermatitis. JAMA Pediatr. 2022;176(11):1156. doi:10.1001/jamapediatrics.2022.3109